Depression and PTSD symptoms among bereaved adolescents 6½ years after the 1988 spitak earthquake

Abstract

Objective

To compare depression and PTSD symptoms of parentally bereaved adolescents and a comparison group after a catastrophic natural disaster.

Method

Six and a half years after the Spitak earthquake, 48 parentally bereaved adolescents and a comparison group of 44 subjects with no parental loss were evaluated using the Depression Self - Rating Scale (DSRS) and Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI).

Results

Orphans scored significantly higher on depression than those who lost a father (Mean DSRS scores: 20.2 ± 3.3 vs. 16.6 ± 5.2; p < 0.001), who in turn scored significantly higher than those who lost a mother (Mean DSRS scores: 16.6 ± 5.2 vs. 12.7 ± 4.1; p < 0.002). Depression scores for orphans fell above the cut-off for clinical depression, while those who lost a father scored slightly below. PTSD scores within each group fell in the moderate range of severity, with girls scoring higher than boys (Mean CPTSD-RI scores: 35.9 ± 11.3 vs. 29.3 ± 10.1; p < 0.04).

Limitation

As self-report instruments were used, responses may have been over- or under- reported. Participants belonged to the same ethnic group and therefore the results may not be generalizable to other populations.

Conclusion

Loss of both parents and, to a lesser degree, loss of a father is a significant risk factor for depression, but not for PTSD. This study extends prior findings documenting post-disaster chronicity of depression and PTSD among bereaved adolescents, and underscores the need for post-disaster mental health and social programs, especially for those who suffer the loss of both parents.

Introduction

Most estimates place the number of orphans worldwide at approximately 143 million (Connolly, 2006). A significant number of these children have been orphaned by catastrophic disasters, including the Indian Ocean tsunami, the Bam earthquake in Iran, and Izmit earthquake in Turkey. The 1988 Spitak Earthquake in Armenia left thousands of children with the loss of one or both parents (NGO-S Insert, 2007). UNICEF (2006) has identified parentally bereaved children as “unprotected”, and at high risk for engagement in hazardous forms of labor with the potential for serious injury, forced sexual exploitation, loss of educational opportunities, malnutrition, and disease. Despite the enormity of this problem, there is a paucity of empirical studies documenting the short and longer-term psychological, functional and life-trajectory consequences for this vulnerable population.

The literature on the consequences of traumatic parental loss describes a range of psychological reactions among children and adolescents which include transient dysphoria (Van Eerdewegh et al., 1982), major depression (Weller et al., 1991), child traumatic grief (Layne et al., 2001), complicated grief (Melhem et al., 2007), impaired social functioning (Elizur and Kaffman, 1982), academic difficulties (Van Eerdewegh et al., 1982, Harris, 1991), anxiety symptoms (Kranzler et al., 1990), and PTSD symptoms (Stoppelbein and Greening, 2000). Cross - study comparisons are made difficult due to within and across study variability in types of traumatic losses, time interval between losses and assessments, and ages of participants. None of these studies had examined children who lost both parents. Only one study (Stoppelbein and Greening, 2000) included an evaluation of PTSD symptoms.

The Spitak Earthquake that struck Northern Armenia in 1988 caused the deaths of over 25,000 people. In Gumri, one of the most devastated cities, 7% of the 250,000 population died, and approximately 50% of the city was destroyed. Epidemiologic studies in this population have indicated higher rates of PTSD and depression commensurate to destruction and loss (Armenian et al., 2000, Armenian et al., 2002). The goal of the present study was to evaluate the long-term psychological sequelae (depression and PTSD) among bereaved adolescents who had lost both, one or no parent after the earthquake.